Kevin F. Wilson

The association between allergy and chronic rhinosinusitis with and without nasal polyps: An evidence-based review with recommendations

The relationship between allergy and chronic rhinosinusitis (CRS) remains ill‐defined and controversial. The association between the 2 is unclear, making an evidence‐based decision of whether to evaluate and treat allergies in CRS patients difficult. The purposes of this systematic review are to (1) examine the relationship between allergy and CRS without nasal polyps (CRSsNP), (2) examine the same for allergy and CRS with nasal polyps (CRSwNP), and (3) recommend evaluation and treatment based on the evidence.

Conditioning the Cochlea to Facilitate Survival and Integration of Exogenous Cells into the Auditory Epithelium

The mammalian auditory epithelium (AE) cannot replace supporting cells and hair cells once they are lost. Therefore, sensorineural hearing loss associated with missing cells is permanent. This inability to regenerate critical cell types makes the AE a potential target for cell replacement therapies such as stem cell transplantation. Inserting stem cells into the AE of deaf ears is a complicated task due to the hostile, high potassium environment of the scala media in the cochlea, and the robust junctional complexes between cells in the AE that resist stem cell integration. Here, we evaluate whether temporarily reducing potassium levels in the scala media and disrupting the junctions in the AE make the cochlear environment more receptive and facilitate survival and integration of transplanted cells. We used sodium caprate to transiently disrupt the AE junctions, replaced endolymph with perilymph, and blocked stria vascularis pumps with furosemide. We determined that these three steps facilitated survival of HeLa cells in the scala media for at least 7 days and that some of the implanted cells formed a junctional contact with native AE cells. The data suggest that manipulation of the cochlear environment facilitates survival and integration of exogenously transplanted HeLa cells in the scala media.

Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term surgical outcomes.

Objective With different mastoidectomy approaches available to the surgeon for treatment of cholesteatoma, we review long-term outcomes of intact canal wall (ICW) mastoidectomy with tympanoplasty. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods All cases of cholesteatoma treated with ICW mastoidectomy by the senior author over a period of 9 years for which at least 2 years of follow-up data exist. Patient and disease information was collected retrospectively and analyzed. Results One hundred forty-eight patients with 156 affected ears were treated and followed for a median of 5.3 years (range, 2.1-14.8). The majority of the operations (144/156, 92%) were staged. Of those that were staged, 51/144 (35%) had residual cholesteatoma at the second stage. Thirteen patients (8%) had recurrence of their cholesteatoma, of which 6 required a subsequent canal wall down (CWD) mastoidectomy. Conclusions ICW mastoidectomy with tympanoplasty continues to be a successful treatment for cholesteatoma. We found a substantial residual rate at the second stage, justifying the necessity of staging in most cases. Recurrence rate of cholesteatoma using this technique is low, as is the progression to CWD mastoidectomy.

Clinical and Pathologic Predictors of Recurrence and Survival in Spindle Cell Squamous Cell Carcinoma

Objective. To determine clinicopathologic predictors of recurrence and survival in patients with spindle cell squamous cell carcinoma (SpSCC). Study Design. Historical cohort study. Setting. Tertiary care hospital. Subjects and Methods. Forty-eight patients (mean age, 65.2 years; 35 men, 13 women) who underwent definitive treatment for pathologically confirmed SpSCC between 1987 and 2009 were identified and reviewed. The main outcome measures were time to recurrence and overall survival, while controlling for clinical and pathologic parameters (age, sex, TNM classification, stage, tumor subsite, smoking status, treatment modality, margin status). Results. Of 48 patients, there were 25 oral cavity, 15 laryngeal, 7 oropharyngeal, and 1 maxillary sinus tumors. Treatment included surgery in 32, radiation in 9, and concurrent chemoradiation in 7 patients. The 3-year overall survival for the cohort was 62% with a median follow-up of 59 months; 52.1% (25/48) of patients developed a recurrence, and 88% (22/25) recurred locally or locoregionally. Recurrence occurred within 2 years in 72% (18/25) of patients. Age, sex, initial T and N classification, overall stage, tumor subsite, smoking status, treatment modality, and margin status were not predictive of recurrence or overall survival. Conclusion. Patients with SpSCC are at high risk of developing locoregional recurrence, but no measured clinical or pathologic parameter was predictive of survival. Although overall survival is similar to that of patients with conventional SCC, closer follow-up should be considered in these patients to allow earlier detection and treatment of these locally aggressive tumors.

Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: Long‐term hearing outcomes

To review long‐term hearing results after intact canal wall mastoidectomy with tympanoplasty for treatment of cholesteatoma and to identify factors associated with improved hearing outcomes.

Treatment of Oral Cavity Venous Malformations with the Nd:YAG Laser Using the Underwater Technique

Mucosal involvement of venous malformations can cause bleeding, pain, and functional impairment. Treatment options include surgery, sclerotherapy, or laser therapy. Neodymium:yttrium aluminum garnet (Nd:Yag) laser therapy has been used to treat mucosal disease, but few studies have focused purely on the oral cavity. We present a retrospective review of 4 patients (5 subsites) with oral cavity venous malformations treated with the Nd:YAG laser using an underwater technique. Photographs of the venous malformations before and after treatment were evaluated by 2 blinded physicians. A visual analog scale was used to rate the treatment. The medical record was reviewed to assess change in symptoms and to note complications. Four sites were rated as having “significant improvement” and 1 site as “some improvement.” Our study demonstrates that the Nd:YAG laser can be a feasible option in the treatment of venous malformations of the oral cavity.

Cricotracheal resection with hilar release for pediatric airway stenosis

OBJECTIVE To determine the effectiveness of cricotracheal resection and hilar release for high-grade, long-segment airway stenosis. DESIGN We identified 16 patients who underwent cricotracheal resection and hilar release, performed from January 1, 2004, through December 31, 2008, and conducted a retrospective review, emphasizing preoperative findings, operative technique, postoperative course, and results. Complete data sets were available for all patients. SETTING Tertiary care childrens hospital. PATIENTS The study population comprised 16 patients younger than 18 years who underwent cricotracheal resection and hilar release performed by a thoracic airway team. All patients had high-grade, long-segment subglottic stenosis or severe, long-segment tracheomalacia. INTERVENTION Cricotracheal resection with hilar release. MAIN OUTCOME MEASURES Decannulation rate and dehiscence rate. RESULTS Of the 16 patients, 15 were successfully decannulated. The one patient who was not decannulated remained ventilator dependent and has regained speech. There were no incidents of anastomotic dehiscence. CONCLUSION Cricotracheal resection with hilar release is a novel and effective way to approach the problem of severe airway stenosis.

An evaluation of the severity and progression of epistaxis in hereditary hemorrhagic telangiectasia 1 versus hereditary hemorrhagic telangiectasia 2

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia whose hallmark symptom is spontaneous recurrent epistaxis. Two major genetic subtypes of this syndrome are HHT1 and HHT2. Severity of epistaxis ranges from occasional low‐volume bleeding to frequent large‐volume hemorrhage. This study evaluated the severity and progression of epistaxis in HHT1 versus HHT2.

Types of Rhinitis

Rhinitis is a familiar disorder affecting up to 20% of the general population. Chronic rhinitis can be broadly classified into allergic, infectious, or nonallergic or noninfectious, which are distinguished mainly by a careful history and allergy testing. The pathophysiology of nonallergic rhinitis likely involves a combination of inflammatory and neurogenic mechanisms that are poorly understood. Treatment involves avoiding the offending agent, when possible, and using appropriate medications to control the patients predominant symptoms.

Perioperative strategies to improve sinus surgery outcomes in patients with cystic fibrosis: a systematic review.

Objectives Review the literature for intraoperative techniques and postoperative practices after functional endoscopy sinus surgery (FESS) that may improve outcomes in patients with cystic fibrosis (CF). Data Sources PubMed and the Cochrane Library. Review Methods A systematic review of the literature was performed. Articles from 1990 to 2012 were searched using the terms sinus surgery and cystic fibrosis with studies limited to the English language and human subjects. Abstracts were reviewed to identify relevant original manuscripts. Bibliographies of relevant articles were examined to identify additional manuscripts. Results The initial PubMed search identified 169 articles. One additional article was identified through the Cochrane Library. After reviewing the abstracts, 41 selected studies were examined in further detail, and 22 articles were ultimately selected for suitability for this review. The bibliographies of these articles were reviewed and no additional articles were identified. Perioperative strategies included postoperative medical therapies, intraoperative techniques and image guidance, intranasal corticosteroid injection, dornase alfa, gene therapy, and second-look procedures. Most studies were limited to case series with relatively small numbers of patients. Very few randomized controlled studies were identified. Conclusion Despite the prevalence of recurrent sinonasal disease after FESS in patients with CF, evidence for definitive perioperative management in this population is lacking. Most recommendations are based on small case series. Multicenter studies to evaluate perioperative strategies that improve FESS outcomes in patients with CF are warranted.